The Dictatorship
Democrats need to start thinking beyond Obamacare
The government shutdown is over, and Democrats have failed to obtain an extension of subsidies for plans under the Affordable Care Act. That means premiums will skyrocket for the tens of millions of Americans who get their insurance through the ACA marketplaces. While Democrats look for other ways to save the subsidies, though, the party also needs to lay the groundwork for a bigger fix to America’s broken health care system.
It’s been a decade and a half since President Barack Obama signed the ACA into law, which in turn came a decade and a half after Bill Clinton’s failed attempt at health care reform early in his presidency. For the last 15 years, Democrats have said the same thing about the Affordable Care Act: The law has done a tremendous amount of good, but it’s far from perfect. Despite the ACA’s successes, our health care system is still a failure in multiple ways, and only one party wants to fix it. The time is now to start planning for the next phase.
Every Democratic president in the 80 years since Truman made at least some attempt to move toward universal coverage and containing costs.
In 1945, President Harry Truman proposed that the federal government provide health insurance to all. “Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health,” he said. “Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection.”
That time, in fact, kept arriving; every Democratic president in the 80 years since Truman made at least some attempt to move toward universal coverage and containing costs. There were successes along the way, including Medicare, Medicaid and the ACA itself. But most Americans are unhappy with the U.S. health care system as a whole, even if many are happy with their own insurance.
Although health care is typically one of the party’s strongest issues, Democrats have largely been on the defensive since the ACA was passed in 2010. They’ve worked hard, mostly with success, to beat back Republican attempts to repeal or undermine it. This has been a necessary and noble effort: Since the ACA’s passage, the share of Americans without health insurance has been cut in halffrom 16% to 8%. But 27 million Americans are still without coverage. That number is expected to increase dramaticallyboth because of the expiration of enhanced subsidies and because Trump’s “big, beautiful bill” includes massive Medicaid cuts and restricts access to ACA marketplaces.
That means Democrats have no choice but to come up with a new plan they can present to the public for health reform — and it has to be more than just reinforcing the ACA.
This will require both policy work and political advocacy, which was exactly what the party did after Clinton’s reform failed. Health policy experts spent years researching and developing ideas, and by the time the 2008 election arrived, the party had coalesced around an outline of what would become the ACA — a combination of subsidies for people in the middle to buy insurance, an expansion of Medicaid and a mandate for everyone to get covered. While Obama, Hillary Clinton and John Edwards argued about the details in that year’s presidential primary, their differences were minor because they were working from a policy consensus that had already taken shape.
Twelve years later, there was another intense debate over health care in a Democratic presidential primary. And though it seemed in 2020 that there was a gulf between the ideas from progressives, such as Sen. Bernie Sanders’ proposal for a single-payer system, and those from the more moderate candidates, including Joe Biden, in truth the whole party had moved left. Even Biden’s plan, which centered on a public option, was far more progressive than the ACA.
Opponents of health care reforms count on Americans believing that we can’t have anything better.
But once he took office, Biden essentially put that plan in a drawer and never spoke of it again. You can argue that he wouldn’t have been able to pass it through a closely divided Congress, but he never tried to build the support that would have made it possible.
So what should Democrats do now? The answer is that they should spend the next couple of years debating it among themselves. Task the policy experts with devising a menu of options, talk to voters, begin advocacy for real reform and see where support builds. Then, when 2028 comes, have the debate during the presidential campaign when the largest number of Americans are paying attention.
My own preference would be to model our next reform on the combination of public and private insurance that’s used successfully in various forms in countries such as Australia, Canada, France and Denmark. In this system, the government provides basic insurance that covers everyone, and people are free to buy supplementary private insurance if they want more benefits. Liberals like it because of the universal coverage, and conservatives like it because rich people can still buy all the benefits they want.
We could get there by expanding Medicaid — which already covers more than 77 million Americans — to everyone under 65, while allowing seniors to keep Medicare. Yes, there would be many details to work out. And powerful forces will array themselves against meaningful reform — not just the GOP, but the many people, organizations and companies that benefit handsomely from the current system.
Opponents of health care reforms count on Americans believing that we can’t have anything better, or at the very least that it can only be a little bit better. But we know that isn’t true, because every other industrialized country on Earth has a national system that is far less expensive than ours, yet still insures all or virtually all residents.
Last weekend, President Donald Trump proposed sending money to Americans instead of to insurance companies. He later said that people will “feel like entrepreneurs” when they’re “able to go out and negotiate their own health insurance.” It’s an incoherent and nonsensical idea that will only make health care expensive. But Republican lawmakers quickly signaled support, with Sen. Rick Scott of Florida saying he was “writing the bill right now.”
Unlike their opponents, Democrats need to be serious about health care. And that means finding the next big proposal to get closer to a system that all Americans can actually count on and afford. It won’t be an easy process, and it won’t be quick. But that makes it all the more important to start now.
The Dictatorship
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President Donald Trump called the celebrations in the streets of Iran “fantastic” following the killing of the country’s supreme leaderAyatollah Ali Khamenei, during a brief phone call with MS NOW on Saturday night.
Trump told MS NOW that he’s seen the celebrations in Iran and in parts of America, after joint U.S.-Israel airstrikes killed Khamenei.
“I think it’s fantastic,” the president said of the celebrations. “I’ve seen them in Los Angeles, also — celebrations.”
“I’ve seen them in Los Angeles, celebrations, celebrations,” Trump said, accentuating the point.
The interview took place roughly 11 hours before the Pentagon announced the first U.S.military casualties of the war. U.S. Central Command said three American service members were killed in action, and five others had been seriously wounded.
Revelry broke out in Iran, the United States and across the globe on Saturday, with Iranians cheering the death of Khamenei, who led Iran with an iron fist for more than 30 years, cracking down on dissent at home and maintaining a hostile posture with the U.S. and Israel.
Asked how he was feeling after the strike on Khamenei, whose death was confirmed just a few hours earlier, Trump said it was a positive development for the United States.
“I think it was a great thing for our country,” he said.
The call — which lasted less than a minute — came after a marathon day, which began in the wee hours of the morning with strikes on Iran and continued with retaliatory ballistic missiles from Tehran targeting Israel and countries in the Middle East region that host U.S. military bases.
The day ended with few answers from the White House to increasing questions about the long-term future of Iran, how long the U.S. will continue operations there, and the metastasizing ramifications it could have on the world stage. In fact, the president has done little to convince the public to back his Iran operation, nor to explain why the country is at war without the authorization of Congress.
On perhaps the most consequential day of his second term, Trump did not give a formal address to the public, nor did he hold a press conference. Instead, he stayed out of public view at Mar-a-Lago, his private club and residence in Palm Beach, Florida, where he attended a $1 million-per-plate fundraising dinner on Saturday evening.
But throughout the day, Trump took calls from reporters at various new outlets, including from MS NOW at around 11 p.m. ET.
The strikes, known formally as “Operation Epic Fury,” came after months of talks over Iran’s nuclear program, and warnings from Trump that he would strike Tehran if they did not agree to his often shifting conditions.
At 2:30 a.m. ET on Saturday, Trump posted a video to social media announcing the operation, which he said was designed to “defend the American people by eliminating imminent threats from the Iranian regime, a vicious group of very hard, terrible people.”
“The lives of courageous American heroes may be lost and we may have casualties. That often happens in war,” Trump said when he announced the strikes on Iran.
Mychael Schnell is a reporter for MS NOW.
Laura Barrón-López covers the White House for MS NOW.
Three U.S. service members were killed and five seriously wounded as the United States and Israel launched attacks on Iran, U.S. Central Command said Sunday morning.
The three service members — the first Americans to die in the conflict — were killed in Kuwait, a U.S. official said.
Several others sustained minor injuries from shrapnel and concussions but will return to duty, the Pentagon said. The identities of the dead and wounded have not been made public.
“The situation is fluid, so out of respect for the families, we will withhold additional information, including the identities of our fallen warriors, until 24 hours after next of kin have been notified,” Central Command said in a statement.
The U.S. and Israel launched sweeping airstrikes on Iranon Saturday, killing Ayatollah Ali Khameneithe country’s supreme leader for nearly four decades. Iran has vowed retaliation and hit several U.S. military bases across the region.
According to U.S. Central Command, Iran has also attacked more than a dozen locations, including airports in Dubai, Kuwait and Iraq, and residential neighborhoods in Israel, Bahrain and Qatar.
Israel Defence Forces said Sunday that Iran fired missiles toward the neighborhood of Beit Shemesh, killing civilians. The missile hit a synagogue, killing at least nine people, according to the Associated Press.
AP reported that authorities said at least 22 people were killed and 120 others wounded when demonstrators tried to attack the U.S. Consulate in Karachi in Pakistan.
The violence came after the United States and Israel attacked Irankilling its Supreme Leader Ayatollah Ali Khamenei. Police and officials at a hospital in Karachi said that at least 50 people were also wounded in the clashes and some of them were in critical condition.
On Sunday, Israel Defence Forces said on X, “It’s official: All senior terrorist leaders of Iran’s Axis of Terror have been eliminated.”
President Donald Trump told CNBC’s Joe Kernen on Sunday that the operation in Iran is “moving along very well, very well — ahead of schedule.”
In a phone call with MS NOW late Saturday, Trump called the celebrations in the streets of Iran “fantastic” following the killing of Khamenei.
Confirming Khamenei’s death, Prime Minister Benjamin Netanyahu said Sunday: “We have eliminated the tyrant Khamenei and dozens of senior figures of the oppressive regime. Our forces are now striking at the heart of Tehran with increasing intensity, set to escalate further in the coming days.”
The exchange of hostilities comes after weeks of fragile negotiations between the U.S. and Iran over Iran’s nuclear operations.
Esmail Baghaei, a spokesperson for Iran’s foreign ministry, called the joint U.S-Israeli attack an “unprovoked, unwarranted act of aggression” in an interview with MS NOW’s Ali Velshi on Sunday. He said Iran’s nuclear program has been used a pretext for the attack.
“We have every right to defend our people because we have come under this egregious act of aggression,” Baghaei said.
Trump announced the attack early Saturday during a short video posted on his Truth Social account. He called for an end to the Iranian regime and urged Iranians to “take back the country.”
Negotiators and mediators from Oman were supposed to meet in Vienna on Monday to discuss the technical aspect of a potential nuclear deal.
Rep. Eric Swawell, D-Calif., told MS NOW’s Alex Witt on Sunday afternoon that the president’s military operation in Iran was illegal, echoing what many lawmakers have said in citing that under the U.S. Constitution only Congress can declare war.
“This is a values argument. We don’t just lob missiles into other countries when we are not provoked, attacked and have no plan for what comes next,” he said.
“We have been shown zero evidence that anything changed in Iran from last year when the president did not come to Congress and took a strike on Iran,” Swalwell said.
In June the U.S. struck three Iranian nuclear sites. Trump said the facilities had been “completely and totally obliterated.” But experts and U.S. officials said the sites were damaged but not destroyed.
Erum Salam is breaking news reporter for MS NOW, with a focus on how global events and foreign policy shape U.S. politics. She previously was a breaking news reporter for The Guardian and is a graduate of Texas A&M University and the Columbia University Graduate School of Journalism. Follow her on X, Bluesky and Instagram.
Akayla Gardner is a White House correspondent for MS NOW.
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